Linagliptin-Metformin, Oral Tablet

Other warnings

• Pancreatitis warning: Linagliptin, one of the medications in this combination drug, may cause pancreatitis (inflammation of your pancreas). Tell your doctor if you have sudden pain in your stomach area that travels to your back, a swollen or tender stomach area, or nausea and vomiting.
• Surgery warning: Having surgery can increase your risk of lactic acidosis. This is a rare but serious condition that’s linked with metformin, one of the medications in this combination drug. If not treated, it can lead to death. To reduce your risk, your doctor may decrease your dosage or stop your use of this medication before surgery. Your doctor may restart the medication after the surgery.
• Warning about tests that use radiocontrast dye: Your doctor will stop your use of this medication if you have an X-ray test that uses dye or contrast. This dye can change how your kidneys work, which could increase your risk of lactic acidosis. This is a rare but serious condition that can lead to death if not treated.

Linagliptin-metformin is a prescription medication that contains two drugs: linagliptin and metformin. It’s important to know about all the drugs in the combination because each drug may affect you in a different way.

Linagliptin-metformin comes as a tablet and an extended-release tablet that you take by mouth. (An extended-release tablet slowly releases medication into your body over time.)

Linagliptin-metformin oral tablet is available as the brand-name drug Jentadueto. It’s not available in a generic form.

Linagliptin-metformin may be used as part of a combination therapy. That means you may need to take it with other drugs.

Why it’s used

Linagliptin-metformin is prescribed to treat type 2 diabetes. It’s used along with diet and exercise to help improve blood sugar levels. It should not be used to treat type 1 diabetes or a condition called ketoacidosis.

How it works

A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Linagliptin belongs to a class of drugs called dipeptidyl-peptidase-4 (DPP-4) inhibitors. Linagliptin helps increase the amount of insulin your body makes. Insulin is a substance that helps move sugar from your bloodstream into your body’s cells. Linagliptin also helps lower the amount of glucose (sugar) your body makes. Together, these actions lower your blood sugar level.

Metformin belongs to a class of drugs called biguanides. Metformin slows down the amount of glucose your liver makes. It also lowers the amount of glucose absorbed by your body, and improves how well your body uses insulin. All of these steps help lower your blood sugar level.

Linagliptin-metformin doesn’t typically cause drowsiness, but it can cause other side effects.

More common side effects

Some of the more common side effects that can occur with linagliptin-metformin include:

• cold-like symptoms (stuffy or runny nose, sore throat, cough)
• diarrhea
• decreased appetite
• nausea or vomiting
• itching

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Lactic acidosis. If you have any of these symptoms, stop taking this medication and go to the emergency room right away:
  • extreme weakness or tiredness
  • unusual muscle pain
  • trouble breathing
  • unexplained stomach pains with nausea, vomiting, and diarrhea
  • cold feeling in arms and legs
  • slow or irregular heartbeat
• Low blood sugar (hypoglycemia)*. Symptoms can include:
  • shaking or jittery feeling
  • sweating
  • fast heartbeat
  • change in vision
  • dizziness
• Allergic reactions. Symptoms can include:
  • swelling of face, lips, or throat
  • trouble swallowing or breathing
  • skin rash
  • hives (raised, itchy bumps)
• Pancreatitis (inflammation of the pancreas). Symptoms can include:
  • sudden pain in stomach area that travels to your back
  • swollen and tender stomach area
• Low vitamin B₁₂ levels. Low levels of vitamin B₁₂ can lead to low levels of red blood cells and hemoglobin in the blood. This condition is called anemia. Your risk of these problems increases with long-term metformin therapy (3 or more years). It also increases if you do not get enough vitamin B₁₂ or calcium from the foods you eat. Symptoms of low vitamin B₁₂ levels can include:
  • tiredness
  • memory problems
  • trouble with balance
• Severe joint pain
• Bullous pemphigoid. Symptoms can include:
  • large, fluid-filled blisters
  • itchy skin

*Treating low blood sugar

If you have a low blood sugar reaction to linagliptin-metformin, you need to treat it:

• For mild hypoglycemia (55–70 mg/dL), treatment is 15–20 grams of glucose (a type of sugar). You need to eat or drink one of the following:
  • 3–4 glucose tablets
  • a tube of glucose gel
  • ½ cup of juice or regular, non-diet soda
  • 1 cup of nonfat or 1% cow’s milk
  • 1 tablespoon of sugar, honey, or corn syrup
  • 8–10 pieces of hard candy, such as LifeSavers
• Test your blood sugar 15 minutes after you treat the low sugar reaction. If your blood sugar is still low, repeat the above treatment.
• Once your blood sugar is back in the normal range, eat a small snack if your next planned meal or snack is more than 1 hour later.

If you don’t treat low blood sugar, you can have a seizure, pass out, and possibly develop brain damage. Low blood sugar can even be fatal. If you pass out because of a low sugar reaction or cannot swallow, someone will have to give you an injection of glucagon to treat the low sugar reaction. You may need to go to the emergency room.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Linagliptin-metformin oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with linagliptin-metformin are listed below.

Antibiotics

Taking rifampin, another antibiotic, with linagliptin can prevent linagliptin from working. Rifampin should not be used with linagliptin-metformin.

Asthma drug

Terbutaline is an asthma drug that can increase your blood sugar levels. This can cause problems with diabetes control if you take linagliptin-metformin.

Blood sugar drugs

These drugs can lower blood sugar levels. Taking them with linagliptin-metformin can cause your blood sugar level to drop too low. The dosages of these drugs may need to be decreased when taken with this medication. This can help reduce the risk of a low blood sugar reaction.

Examples of these drugs include:

• glipizide
• glyburide
• nateglinide
• repaglinide
• insulin

Cholesterol drug

Niacin is a cholesterol drug that can increase your blood sugar levels. This can cause problems with diabetes control if you take this drug with linagliptin-metformin.

Heart drugs

Certain heart drugs can increase your blood sugar levels. This can cause problems with diabetes control if you take linagliptin-metformin. Examples of these drugs include:

• amiloride
• digoxin
• triamterene
• quinidine
• procainamide

Other heart drugs can increase your blood sugar levels. This can cause problems with diabetes control if you take linagliptin-metformin. Examples of these drugs include:

• hydrochlorothiazide
• calcium channel blockers, such as:
  • amlodipine
  • verapamil

Heartburn drugs

Taking certain heartburn drugs with metformin can increase the amount of metformin in your body. This could cause unwanted side effects and increase the risk of lactic acidosis. Examples of these drugs include:

• cimetidine

Nasal congestion drugs

Some of these drugs can increase your blood sugar levels. This can cause problems with diabetes control if you take them with linagliptin-metformin. Examples of these drugs include:

• pseudoephedrine
• naphazoline

Oral contraceptive drugs and estrogens

These drugs can increase your blood sugar levels. This can cause problems with diabetes control if you take them with linagliptin-metformin. Examples of these drugs include:

• oral contraceptives that contain ethinyl estradiol
• conjugated estrogens

Seizure drugs

Taking the seizure drug zonisamide with metformin can increase the risk of lactic acidosis linked with metformin.

Taking phenytoin, another seizure drug, can increase your blood sugar levels. This can cause problems with diabetes control if you take it with linagliptin-metformin.

Seizure and migraine drug

Taking topiramate, a drug that can be used to treat seizures or migraines, with metformin can increase the risk of lactic acidosis linked with metformin.

Thyroid drugs

Certain thyroid drugs can increase your blood sugar levels. This can cause problems with diabetes control if you take them with linagliptin-metformin. Examples of these drugs include:

• levothyroxine
• liotrix
• liothyronine
• desiccated thyroid

Tuberculosis drug

Taking isoniazid can increase your blood sugar levels. This can cause problems with diabetes control if you take it with linagliptin-metformin.

Drugs for glaucoma, seizures, and edema

Taking drugs used to treat glaucoma, seizures, and fluid build-up (edema) with metformin can increase the risk of lactic acidosis linked with metformin. Examples of these drugs include:

• acetazolamide

Drugs to treat allergic reactions or low blood pressure

Some of these drugs can increase your blood sugar levels. This can cause problems with diabetes control if you take them with linagliptin-metformin. Examples of these drugs include:

• epinephrine
• dopamine

Other drugs

Certain drugs can increase your blood sugar levels. This can cause problems with diabetes control if you take them with linagliptin-metformin. Examples of these drugs include:

• corticosteroids, such as:
  • methylprednisolone
  • prednisone

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

Linagliptin, one of the medications in this combination drug product, can cause a severe allergic reaction. Symptoms can include:

• swelling of lips, throat, or face
• trouble breathing or swallowing
• raised, red areas on your skin (hives)
• skin problems (including itching, flaking, peeling or rash)

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

Avoid drinking alcohol while you take this drug. This drug contains metformin. Drinking alcohol while taking metformin raises your risk of lactic acidosis. This condition is rare but serious. If lactic acidosis is not treated, it can lead to death.

Warnings for people with certain health conditions

For people with kidney disease: Metformin is one of the medications in this combination drug product. If you have poor kidney function, you should not take metformin. This is because levels of metformin can build up in your blood if your kidneys are not working well. This can cause dangerous side effects. People with severe kidney disease have the highest risk of lactic acidosis from metformin use, so don’t take this drug if you have severe kidney disease. Kidney disease also raises your risk of heart failure from this drug.

For people with liver problems: Metformin is one of the medications in this combination drug product. Using metformin when you have liver damage can increase your risk of lactic acidosis. Your doctor will test your liver function before and during your treatment with this medication.

For people with low levels of vitamin B₁₂: Metformin is one of the medications in this combination drug product. The use of metformin can lower the levels of vitamin B₁₂ in your blood. If you already have low levels of vitamin B₁₂ or have anemia (low levels of red blood cells), these conditions can get worse.

Your doctor will monitor your vitamin B₁₂ levels at least once a year. If you have low levels, you will be tested or monitored for anemia. This is because low levels of B₁₂ can cause anemia. You may need to have a vitamin B₁₂ injection.

For people with pancreatitis: Linagliptin is one of the medications in this combination drug product. The use of linagliptin may cause pancreatitis (inflammation of your pancreas). It can also worsen this condition if you already have it.

You should not use this product if you’re having an episode of pancreatitis. If you may have pancreatitis, you should stop taking this medication. You should be tested for pancreatitis and treated, if needed.

For people with or at risk of heart failure: This drug increases your risk of heart failure. Call your doctor right away if you develop new or increased symptoms of heart failure. These can include dizziness, tiredness, shortness of breath, swelling of your legs or feet, or unexplained weight gain. This drug also increases your risk of lactic acidosis.

For people with a history of heart attack: Metformin is one of the medications in this combination drug product. If you’ve had a heart attack in the past, using metformin can increase your risk of lactic acidosis.

For people with alcohol use disorder: If you have alcohol use disorder, you should not use this drug. This drug contains metformin. Drinking alcohol while taking drugs that contain metformin increases your risk of lactic acidosis.

Warnings for other groups

For pregnant women: There aren’t enough studies done in pregnant women to show if linagliptin-metformin poses a risk to a fetus when a woman takes this drug. Studies of the drug in pregnant animals have not shown a risk. However, animal studies do not always predict the way humans would respond. This drug should only be used in pregnancy if clearly needed.

Talk to your doctor if you’re pregnant or planning to become pregnant.

For women who are breastfeeding: It’s not known if linagliptin-metformin passes into breast milk. Metformin alone appears in breast milk in small amounts. This drug can lower blood sugar levels. So, this combination product may cause low blood sugar in your child if you breastfeed.

Talk to your doctor if you are breastfeeding. You should decide together if you should stop taking this drug or stop breastfeeding.

For seniors: If you’re age 80 years or older, your doctor will test your kidney function before and during treatment with this medication. This is because seniors are more likely to have decreased kidney function. If you have kidney disease, you should not take metformin (one of the drugs in this combination product).

Also, your body may process this medication more slowly. Your doctor may monitor you closely to see if this drug is lowering your blood sugar too much.

All possible dosages and drug forms may not be included here. Your doctor will tell you what dosage is right for you. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Drug forms and strengths

Brand: Jentadueto

• Form: immediate-release oral tablet
• Strengths:
  • linagliptin 2.5 mg/metformin 500 mg
  • linagliptin 2.5 mg/metformin 850 mg
  • linagliptin 2.5 mg/metformin 1,000 mg

Dosage for type 2 diabetes

Adult dosage (ages 18–64 years)

• Typical starting dosage: To prevent stomach upset, your doctor may start you with a lowered dosage of one tablet of 2.5 mg of linagliptin and 500 mg of metformin, once per day.
• Dosage increases:
  • After 3–5 days, your doctor may have you take this tablet twice per day.
  • After a few weeks, your doctor may slowly increase your dosage. This depends on how well the medication controls your blood sugar level.
• Maximum dosage: 5 mg of linagliptin and 2,000 mg of metformin per day.

Child dosage (ages 0–17 years)

This medication has not been studied in children. It should not be used in anyone younger than 18 years.

Senior dosage (ages 65 years and older)

Your body may process this drug more slowly. Your doctor may start you on a lowered dosage to keep the drug from building up too much in your body. Too much of the drug in your body can be dangerous.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Linagliptin-metformin oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: Your blood sugar level will likely rise. If your blood sugar level is high and not controlled for a long time, you can have serious complications. These include a condition called diabetic ketoacidosis. This can be fatal (cause death).

You will also be at higher risk for long-term complications from diabetes that could be disabling or life-threatening. They include problems with your nerves, eyes, kidneys, feet, and skin. They also include heart and blood vessel disease.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. In order for this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You may have a low blood sugar reaction (hypoglycemia). If you do, you need to treat the reaction (see “Treating low blood sugar” above).

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take it as soon as you remember. But if you remember just a few hours before the time for your next dose, then only take one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: Your doctor may have you check your blood sugar each day using a blood glucose meter. Your doctor will tell you where to get this device and how to use it. Also, about four times each year, your doctor will do a blood test. This is called an A1C test (HgbA1C).

If this drug is working, these tests will show that your blood sugar level has lowered to a number within a certain range. Your doctor will tell you what range is best for you.

Keep these considerations in mind if your doctor prescribes linagliptin-metformin for you.

General

• You can take this drug with food. Taking this drug with food helps to prevent an upset stomach.
• Take this drug two times per day.
• Don’t break, cut, or crush the tablets.

Storage

• This drug must be stored at the right temperature.
• Store linagliptin-metformin tablets at room temperature between 68°F and 77°F (20°C and 25°C). If needed, they can be kept for a short time at temperatures of 59°F to 86°F (15°C to 30°C).
• Don’t store this medication in moist or damp areas, such as bathrooms.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport x-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

Your doctor may have you test your blood sugar (glucose) level with a home blood glucose meter. By checking your blood sugar level at home, you’ll be able to tell if it’s within the correct range for you.

You may need to buy the following items to help you monitor your blood sugar level:

• sterile alcohol wipes
• lancing device and lancets (pricking needles used to draw a drop of blood for testing)
• blood glucose test strips
• a blood glucose meter
• a sharps container (a bin for safe disposal of used lancets)

Your doctor will tell you what to do if your blood sugar level is too low or high. Your doctor will also have you log your home blood sugar testing results. Based on your results, your doctor may decide to adjust your diabetes medication.

Clinical monitoring

You will need to have your blood sugar level monitored while you take linagliptin-metformin. This will help make sure your level is within the range your doctor feels is best for you. The tests will check if your medication is working.

This monitoring may be done using two tests:

• Blood sugar level. Your doctor may tell you to check your blood sugar level each day using a blood glucose meter. Your doctor will tell you where to get this device and how to use it.
• A1C test (HgbA1C). Your doctor will do this blood test about four times each year.

Your doctor may also do blood tests to check if it’s safe to start or to continue taking this medication. The tests may include:

• kidney function tests (blood creatinine levels, creatinine clearance, or both)
• liver function tests
• eye exam (at least once a year)
• foot exam (at least once a year)
• dental exam (at least once a year)
• tests for nerve damage
• test to check cholesterol levels
• tests to check blood pressure and heart rate
• blood test to check your levels of vitamin B₁₂
• complete blood count to check for anemia

Your diet

Metformin, one of the drugs in this combination product, can decrease the levels of vitamin B₁₂ in your blood. Be sure to eat enough foods that provide vitamin B₁₂ or calcium. Foods that contain both of these nutrients include milk, cheese, and yogurt.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Hidden costs

If your doctor tells you to monitor your blood sugar level at home, you’ll need to purchase:

• sterile alcohol wipes
• lancing device and lancets (pricking needles used to draw a drop of blood for testing)
• a blood glucose meter
• blood glucose test strips
• a sharps container (a bin for safe disposal of used lancets)

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription. Your insurance company may require you to take each drug in this combination product alone before you can switch to the combination tablet.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.